Sound and Speech Disorder, formerly known as Verbal Dyspraxia, is a member of the large family of language disorders. It shares commonalities with DCD/motor dyspraxia in that the difficulty is related to poor planning of motor movements that affect language (this is referred to as verbal/orofacial/buccofacial dyspraxia).

Sound and Speech Disorder is an expressive language disorder characterized by the inability to adequately plan and organize mouth movements to produce sounds, words or certain actions such as blowing, drinking through a straw, sticking out the tongue, etc. This disorder leads to a marked limitation in the number of words produced, in pronunciation, in verbal fluency and, consequently, in speech intelligibility. Comprehension is not greatly affected. A child with a sound and speech disorder (verbal dyspraxia) will therefore have difficulty being understood by those around him, even though he will understand what is said to him and will know perfectly well what he means.

Children with this disorder are more likely to also have motor difficulties in the form of DCD/dyspraxia.
This language disorder should not be confused with developmental language disorder (dysphasia), in which both expressive and receptive language may be affected.

It is usually around the age of 3 that a referral to speech therapy is made when the parent suspects a language difficulty. After the diagnosis, the child can benefit from rehabilitation that will aim to make the movements that allow the production of sounds automatic.

Many children with DCD experience learning difficulties at some point in their school career. The difficulties may be in a variety of subjects and may vary in intensity depending on the child and his/her grade level.
In kindergarten, the child may not be good at colouring and cutting and may have difficulty fitting together pieces of building sets or puzzles. They tend to repeat the same games and watch their peers rather than play with them.

In primary school, learning to write is particularly difficult; the child picks up his pencil awkwardly and inefficiently, has great difficulty forming his letters and is slower than his peers. As the years go by, learning mathematics also becomes more and more laborious, and subjects such as physical education, music and art, far from being pleasurable, are instead sources of failure and frustration that contribute to lowering self-esteem.

In high school, if the academic difficulties experienced in elementary school tend to continue, it is the new organizational requirements that represent the greatest challenge for the young person with a DCD/dyspraxia. Indeed, the transition to high school brings about many changes, both academically and socially, as well as in terms of autonomy. In order to make this transition successfully, the young person will need support and compensatory means that will help him/her to succeed.

On the other hand, if the child has significant and persistent difficulties in one or other of the school learning processes, a specific diagnosis may be made. This is called dyslexia/dysorthographia for a disorder in the identification and production of words in writing that affects reading and writing, or dyscalculia for a disorder in mathematical activities.

Since 2015, the diagnosis of ASD is no longer an exclusion criterion for DCD and it is therefore possible for a child to present both disorders concurrently. Thus, in addition to having deficits in planning and motor coordination, the child will need to demonstrate difficulties in social relationships and variety of interests to receive both diagnoses.

There is a growing body of scientific evidence that children/persons living with DCD/dyspraxia are more likely to have mental health problems, including anxiety symptoms, depressive symptoms, social difficulties and behavioural problems. Indeed, DCD/dyspraxia causes children to experience emotional difficulties related to their poor motor skills, such as: a low sense of competence, a decrease in their ability to meet everyday expectations, and a decrease in their social participation. All of this contributes to lower overall self-esteem.
Three elements inherent to DCD/dyspraxia, can explain the difficulties on an emotional or psychological level:

• The invisible nature of the disability: this is a source of ambiguity for the child, which can be amplified by the misunderstandings experienced by the family and those around them.
  
  
• Misattributions: On the one hand, the child knows that something is wrong without being able to explain it. On the other hand, family, friends, teachers, coaches may attribute the child’s limitations to other causes. The child may come to believe that he is not good, that he is not smart. Children with DCD/dyspraxia are often mislabeled as “lazy”, “not very diligent”, “not very motivated”, “not very active”. These misattributions can lead to the development of anxiety symptoms and, more importantly, have a strong negative impact on self-esteem as the child comes to see only his or her limitations and difficulties.

• Repeated failure: this is called performance anxiety or “anxiety about future failure”. This state is likely to further decrease the child’s performance and motivation to participate in various activities. As a result, the child may gradually develop a fear of engaging in such activities as a result of being confronted with difficulties. In all cases, avoidance of motor activities or social situations and exclusion may result.

The term visuospatial dyspraxia is often confusing and is not officially recognized in the DSM-5. Nevertheless, many children with DCD/dyspraxia may also have symptoms of visuospatial dyspraxia. This is based on two main elements:

• Incoordination in eye movements and impairment in the organization of the gaze: difficulty in staring, in following an object with the eyes, in making an effective visual scan, in visually exploring the environment and in locating a particular element. This difficulty may be present with or without a vision disorder.
  
  
• Poor spatial organization: difficulty locating oneself in space, locating an object in relation to oneself and understanding the position of objects in relation to each other.

As one might expect, visuospatial dyspraxia has many repercussions in the child’s life. In addition to those already described in the general picture of DCD/dyspraxia, some difficulties will be added, for example:

• At home, the child may put on his clothes or shoes backwards or look for his toys in his environment often.
  
  
• At school, difficulties may be present in reading (decoding, sense of reading, locating information in a text, confusion of letters, slowness and visual fatigue), in writing (sense of letters, copying from the board, respecting the spacing between words), in mathematics (alignment of numbers in operations, geometry), in his organization (classifying his personal belongings, finding his way around the school)

Here are the questions to ask when making an optometry appointment (according to Jean Pierre Lagacé optometrist):

Beyond the conventional visual examination (visual acuity test, estimation of hyperopia, myopia or astigmatism, eye health):

• Do you do eye alignment and focus tests, especially for near vision?
• Do you do visual-motor tests (eye movements, reading speed test, etc.)?
• Do you test visual perception (visual memory, hand-eye coordination, visualization, visual discrimination, etc.)?
• Do you do spatial location/orientation tests?
• Do you offer structured vision rehabilitation treatment for all these problems (e.g. monthly visits lasting 6-12 months depending on the problems encountered) and not just one or two activities with follow-up in 6 months?